Forgot Milk?

What Families Can Learn from the U.S. Formula Shortage

One thing the pandemic and related supply chain shortages have revealed is how very fragile our food system is. One chicken-slaughtering house is shut down, and the whole nation faces a shortage for months. Mass panic begins, and toilet paper is nowhere to be found. Eggs, milk, various types of meat, produce—all have faced periods of shortage and consequent price hikes.

But perhaps no shortage has been more terrifying for parents than that in infant formula, which began during the pandemic but was deeply exacerbated when Abbott Labs shut down formula production at its Sturgis, Michigan plant in February 2022.¹ It all began when the FDA investigated the deaths of two infants from a bacteria found in infant formula. Traces of a pathogen (Cronobacter sakazakii) were found at the Michigan Abbott plant, and although it is not clear that this particular pathogen at this plant was responsible for the deaths, the plant was nonetheless shut down for further investigation and clean-up (some other unsanitary conditions, including standing water, were also discovered).

But this one event was just the tipping point; the scene had long been set for a dramatic formula shortage. To begin with, the formula market in America is dominated by only three companies: Abbott, Mead Johnson, and Gerber, with the first two making up 80 percent of all sales. Infant formula is relatively difficult to produce and is subject to stringent safety requirements, so the manufacturers tend to outfit whole factories devoted to just that product. When one factory has to close, the market reels.

Regulatory and trade issues affect supply as well. The U.S. has different requirements for formula than European countries have (not necessarily better, but different), so importing most formulas is impossible. It is also a heavily tariffed product, which makes it unappealing to import.

When Helping Hurts

Then there is the role of government subsidy. As one Vox story points out, “Abbott and Mead Johnson haven’t dominated the formula market on their own. The federal government has helped.”² Through the Women, Infants, and Children program (WIC), the federal government subsidizes more than half of formula purchases by giving rebates to certain manufacturers. In practice, this has meant that when an individual state chooses to work with a specific formula manufacturer, that manufacturer has a virtual monopoly in that state. When, for example, Abbott lost California’s WIC contract, it went from holding 90 percent of that state’s formula market to a mere 5  percent.

The demand for formula has also oscillated dramatically in the past two years. When the pandemic hit in 2020, parents feared future shortages and stocked up, causing price increases and, ironically, the very shortages they feared. Then, as they worked through their stockpiles, demand lessened—causing manufacturers to produce less. To further complicate matters, research by Lyman Stone found a slight uptick in births in early 2022, along with a “dramatic” decrease in breastfeeding. The fluctuating demand itself has made it difficult for manufacturers to know how much formula to make.

The U.S. government has been scrambling to get more formula produced and imported, but the current shortage lays bare the problems of industrialized life. There have always been women who have been unable, for one reason or another, to nurse their babies, but there have also been other women who have been able to step in and fill those gaps.

Infant formula does fill a need, but the formula industry did much to create more “need” by handing out free formula to hospitals in the 1950s. Nurses were encouraged to feed infants formula first, during what is a very delicate and crucial time for the establishment of breastfeeding. When mothers saw how easy formula seemed to be (and probably also struggled with their own supplies of breastmilk once they brought their babies home), they were won over. Formula feeding surged in the 1950s and 1960s, an era corresponding with the push to get ever more able-bodied women into an office chair.

But for reasons nutritionists have never been able to nail down, infant formula has never been quite as good as breastmilk. The benefits of breastfeeding—and I do mean breastfeeding here, not feeding pumped breastmilk (which has been much less researched)—are extensive and long-lasting, so much so that the CDC and other regulatory bodies have strongly encouraged it since the 1970s. In spite of this, American mothers in particular struggle to breastfeed their children. Although exclusive breastfeeding is recommended for at least the first six months of a child’s life, only 25 percent of babies nationwide meet that goal.³ Roughly 20 percent of breastfed infants receive formula supplementation in the first two days of life—interfering with the crucial supply-demand link with the mother’s body.

One response to the current crisis has been simply to cry out “Breastmilk is free!” This is a deeply uncompassionate and ignorant answer, for a number of reasons. First, if you haven’t gone through the work of breastfeeding exclusively in those first few precious days, chances are that your supply of breastmilk is never going to recover. Mothers can’t suddenly start producing enough milk to feed their infants, much as some of them would like to right now.

But second, and perhaps even more importantly, the population least able to breastfeed “for free” are the low-income women. Women who have to return to work shortly after giving birth, or who receive WIC assistance, or who are single mothers without the support of the baby’s father are overwhelmingly more likely to feed their babies formula. Breastfeeding is vastly time-consuming and thus extremely difficult for many women.

Toward Family Sustainability

What all this reveals is that problems arise when the family outsources its most basic functions—in this case, feeding its most vulnerable members—to industry and government. But there are things individual families can do to create a more sustainable system. The first step is simply to shrink the system by taking back as many functions into one’s own home as possible.

In the case of remedying a formula shortage, this would first involve efforts to break up the monopolies. If you do rely on formula, try to find smaller manufacturers. If you haven’t begun the journey of having babies yet, consider what changes you might make now to make breastfeeding possible. Local communities and hospitals could organize groups of breastfeeding women to support each other, not only with encouragement and education, but also with informal networks of breastmilk. The true, pie-in-the-sky target is for policymakers to recognize this first crucial link between parent and child and do all in their power to ensure that every woman can be at home with her children at least for the first few months to establish good breastfeeding habits.

It may seem ridiculous that in the most prosperous nation on earth, parents are scrambling to find food for their children. But this is a man-made crisis in every way, and government attempts to help have often made it worse. With a bit of creativity and thoughtfulness, we can remedy this crisis and restore local, family-based food economies.

Notes
1. Derek Thompson, “What’s Behind America’s Shocking Baby-Formula Shortage?” The Atlantic (May 12, 2022): theatlantic.com/ideas/archive/2022/05/baby-formula-shortage-abbott-recall/629828.
2. Dylan Scott, “Why There’s Still a Formula Shortage,” Vox (June 2, 2022): vox.com/policy-and-politics/2022/6/2/23151583/abbott-baby-formula-shortage-wic-biden-trump.
3. Centers for Disease Control, “Breastfeeding Report Card,” 2020: cdc.gov/breastfeeding/data/reportcard.htm.